DOCSLIB.ORG

Compounding Health Risks and Increased Vulnerability to SARS-Cov-2 for Racial and Ethnic Minorities and Low Socioeconomic Status Individuals in the United States

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Compounding Health Risks and Increased Vulnerability to SARS-Cov-2 for Racial and Ethnic Minorities and Low Socioeconomic Status Individuals in the United States Preprints (www.preprints.org) | NOT PEER-REVIEWED | Posted: 15 April 2020 doi:10.20944/preprints202004.0234.v1 Compounding Health Risks and Increased Vulnerability to SARS-CoV-2 for Racial and Ethnic Minorities and Low Socioeconomic Status Individuals in the United States Elise M. Myers1 [email protected] 1Columbia University; 535 W 116th Street, New York, NY 10027 Abstract Recent clinical SARS-CoV-2 studies link diabetes, cardiovascular disease, and hypertension to increased disease severity. In the US, racial and ethnic minorities and low socioeconomic status (SES) individuals are more likely to have increased rates of these comorbidities, lower baseline health, limited access to care, increased perceived discrimination, and limited resources, all of which increase their vulnerability to severe disease and poor health outcomes from SARS-CoV- 2. Previous studies demonstrated the disproportionate impact of pandemic and seasonal influenza on these populations, due to these risk factors. This paper reviews increased health risks and documented health disparities of racial and ethnic minorities and low SES individuals in the US. Pandemic response must prioritize these marginalized communities to minimize the negative, disproportionate impacts of SARS-CoV-2 on them and manage spread throughout the entire population. This paper concludes with recommendations applicable to healthcare facilities and public officials at various government levels. Keywords: Coronavirus, COVID-19, comorbidity, race and ethnicity, health disparities Introduction The novel human coronavirus, severe acute respiratory syndrome coronavirus (SARS-CoV-2 or COVID-19), was declared a pandemic by the WHO on March 11, 20201. Since the January 15th arrival of the first documented case in the United States, the disease has been rapidly spreading through the country, reaching every state and the District of Columbia (DC) by March 17th. As of April 8, 2020, there have been 554,849 confirmed cases and 21,942 deaths nationwide, with every state, DC, and 4 of 8 territories reporting cases2. Rising wealth inequality3 and persistent social disparities experienced by racial and ethnic minorities in the US4 lead to significant vulnerability of racial and ethnic minorities and low socioeconomic status (SES) individuals to pandemic events5. Already, there have been reports of disproportionate prevalence and severity of SARS-CoV-2 cases among Blacks6,7,8,9, and American Indians10*. Previous research has highlighted the disproportionate impact of the H1N1 Influenza A pandemic11,12,13,14,15 and seasonal influenza16,17,18 on both racial and ethnic minorities and low SES individuals. Existing disparities for racial and ethnic minorities and low SES individuals in the US, combined with evidence of disproportionate impacts of influenza, suggest that SARS-CoV-2 will have a devastating impact on these vulnerable populations. This articles reviews: 1) recent findings related to comorbidities and SARS-CoV-2 case severity, 2) disparities in health and healthcare © 2020 by the author(s). Distributed under a Creative Commons CC BY license. Preprints (www.preprints.org) | NOT PEER-REVIEWED | Posted: 15 April 2020 doi:10.20944/preprints202004.0234.v1 for racial and ethnic minorities in the US, 3) health risks associated with lower SES, and 4) compounding risk at the intersection of low SES and racial and ethnic minority identity. To conclude, recommendations for minimizing the impact of the SARS-CoV-2 pandemic on vulnerable populations are provided for both inside healthcare facilities and at various community organization and government levels. SARS-CoV-2 Risks for Patients with Comorbidities From recently available data on patients from the early stages of the outbreak of SARS-CoV-2 in China, it is increasingly apparent that, in addition to older patients19, patients with comorbidities have a higher likelihood of severe disease and an increased risk of death20. Recent studies report a range of 40-63% of severely or critically ill hospitalized patients have comorbidities19,20,21,22,23, similar to ranges reported for Middle East Respiratory Syndrome coronavirus (MERS-CoV)24. Further, patients with severe disease are more likely to have a co-existing illness than patients with non-severe disease25. The most common comorbidities reported in these early studies are hypertension, diabetes mellitus, and cardiovascular disease19,21,25,26, all of which have been correlated to increased mortality risk19 and severe disease25 in SARS-CoV-2 patients. Pre-existing cardiovascular disease and diabetes previously have been linked to acute cardiac events and poor health outcomes for patients with influenza and respiratory infections27,28,29,30,31. One hypothesis for increased SARS-CoV-2 severity with hypertension and diabetes is that both conditions can be treated with angiotensin-converting enzyme (ACE) inhibitors and angiotensin II type-I receptor blockers (ARBs), which increase the expression of ACE232,33. Because human pathogenic coronaviruses bind to target cells via ACE 2, treatment of hypertension and diabetes with ACE inhibitors and ARBs could facilitate SARS-CoV-2 infection and increase disease severity34. Alternative treatments for patients with hypertension and diabetes that do not increase ACE 2 expression may be important to implement34. In addition, individual-specific treatment plans to address serious comorbidities alongside pneumonia have been recommended23. Chronic lung or respiratory system disease19,21,26, cerebrovascular disease21,25, chronic kidney disease19 and a history of smoking21 are other comorbidities reported in patients with more severe cases of SARS-CoV-2. Of these comorbidities, chronic lung disease and chronic kidney disease significantly correlate with increased mortality risk19. Notably missing from studies is concrete information on the effect of asthma on SARS-CoV-2 severity, which has been attributed to the low prevalence in the general population in China26. Generally, the presence of any comorbidity increased the risk of severe illness and mortality for SARS-CoV-2 hospitalized patients20,25,26. In one study, 23% of SARS-CoV-2 critically ill patients had aggravated disease that was attributed to their original comorbidity23. Previous work demonstrated that diabetes, hypertension, obesity, and cardiovascular disease correlate with case severity of other coronaviruses, including MERS-CoV24 and influenza illness35,36. Recent studies have also demonstrated that SARS-CoV-2 infections can cause damage to various organs (i.e. heart, liver, and kidneys) and organ systems (i.e. blood and immune)21,37. Damage to organs and organ systems that are already compromised by comorbidities likely contributes to the complication of organ system and organ failure19-22. Preprints (www.preprints.org) | NOT PEER-REVIEWED | Posted: 15 April 2020 doi:10.20944/preprints202004.0234.v1 It is important to note that data from hospitalized patients does not reflect the total disease burden of the general population, in which an estimated 80% of total SARS-CoV-2 cases are likely mild38 and do not require hospitalization. However, data on hospitalized patients provides insight into which subpopulations are more vulnerable to severe disease and higher mortality risk. Elevated Risk for Severe SARS-CoV-2 for Racial and Ethnic Minorities in the United States Elevated Risks for Seasonal Influenza, Pneumonia, and Respiratory Infections Disparities in morbidity and mortality for racial and ethnic groups have been previously identified in respiratory diseases, including pneumonia and seasonal influenza39,40,41. The US has a long history of health disparities for seasonal and pandemic influenza, with higher mortality rates for Black vs. non-Hispanic white (NHW) populations reported from the 1918-1919 influenza pandemic42,43 through to modern day5,16,44. Hospitalization rates for Black and Hispanic children are higher than those of NHWs for respiratory syncytial virus, seasonal influenza, and parainfluenza viruses17. Further, rates of respiratory viral infections are higher for Apache Indians, Alaska Natives and Blacks than for NHWs45. These aforementioned differences align with the larger trend that influenza-associated pneumonia and pandemic influenza-related deaths are more common in racial and ethnic minority populations16,40,46,47. The increased risks to racial and ethnic minorities in the United State in the current SARS-CoV- 2 pandemic are similar to those highlighted during the 2009 H1N1 novel influenza A pandemic. An estimated 60.8 million cases of H1N1 with 274,304 hospitalizations and 12,469 deaths occurred in the US from April 2009 to April 201048. The current SARS-CoV-2 pandemic has caused more deaths in the US in under 3 months (21,942 deaths as of April 13, 20202), demonstrating the increased severity of the current pandemic and underlining the need to examine and apply past lessons to protect vulnerable populations. Severe cases of H1N1 in the United States were found to disproportionately impact racial and ethnic minorities, as noted through age-adjusted hospitalization rates and deaths11,12,49. Hospitalizations related to H1N1 were most common for American Indians and Alaska Natives12, though Hispanics and Blacks also were hospitalized at higher rates than NHWs12,49. In fact, American Indians were 2.6 times more likely to be hospitalized than NHWs13, while Alaska Native and Asian/Pacific Islanders were 2-4 times likely to be hospitalized than NHWs during the H1N1 pandemic14. Overall,
Load more

Recommended publications
  • Trends and Inequalities in Young Child Nutrition in Rwanda [FA109]
    Trends and Inequalities in Young Child Nutrition in Rwanda Further Analysis of the 2014-15 Demographic and Health Survey DHS Further Analysis Reports No. 109 Republic of Rwanda Trends and Inequalities in Young Child Nutrition in Rwanda: Further Analysis of the 2014-15 Demographic and Health Survey DHS Further Analysis Reports No. 109 Jennifer Yourkavitch ICF Rockville, Maryland, USA January 2018 Corresponding author: Jennifer Yourkavitch, International Health and Development, ICF International, 530 Gaither Road, Suite 500, Rockville, MD 20850, USA; phone: +1 301-407-6500; fax: +1 301-407-6501; email: [email protected] Acknowledgment: The author would like to thank Shireen Assaf and Tom Pullum for advice and feedback on data analysis, Rukundo Benedict and Sorrel Namaste for technical input, and Chris Gramer for assistance with the dashboards. Editor: Bryant Robey Document Production: Joan Wardell This report presents findings from a further analysis undertaken as part of the follow-up to the 2014-15 Rwanda Demographic and Health Survey (RDHS). ICF provided technical assistance for the project. This report is a publication of The DHS Program, which is designed to collect, analyze, and disseminate data on fertility, family planning, maternal and child health, nutrition, and HIV/AIDS. Funding was provided by the U.S. Agency for International Development (USAID) through the DHS Program (#AID-OAA-C-13-00095). The opinions expressed here are those of the authors and do not necessarily reflect the views of USAID and other cooperating agencies. The Rwanda Demographic and Health Survey 2014-15 (2014-15 RDHS) was implemented by the National Institute of Statistics of Rwanda (NISR) from November 9, 2014, to April 8, 2015.
    [Show full text]
  • Introducing Risk Inequality Metrics in Tuberculosis Policy Development M.Gabriela M.Gomes, Juliane F
    Introducing risk inequality metrics in tuberculosis policy development M.Gabriela M.Gomes, Juliane F. Oliveira, Adelmo Bertolde, Diepreye Ayabina, Tuan Anh Nguyen, Ethel Leonor Noia Maciel, Raquel Duarte, Binh Hoa Nguyen, Priya B Shete, Christian Lienhardt To cite this version: M.Gabriela M.Gomes, Juliane F. Oliveira, Adelmo Bertolde, Diepreye Ayabina, Tuan Anh Nguyen, et al.. Introducing risk inequality metrics in tuberculosis policy development. Nature Communications, Nature Publishing Group, 2019, 10, pp.2480. 10.1038/s41467-019-10447-y. hal-02474655 HAL Id: hal-02474655 https://hal.archives-ouvertes.fr/hal-02474655 Submitted on 11 Feb 2020 HAL is a multi-disciplinary open access L’archive ouverte pluridisciplinaire HAL, est archive for the deposit and dissemination of sci- destinée au dépôt et à la diffusion de documents entific research documents, whether they are pub- scientifiques de niveau recherche, publiés ou non, lished or not. The documents may come from émanant des établissements d’enseignement et de teaching and research institutions in France or recherche français ou étrangers, des laboratoires abroad, or from public or private research centers. publics ou privés. ARTICLE https://doi.org/10.1038/s41467-019-10447-y OPEN Introducing risk inequality metrics in tuberculosis policy development M. Gabriela M. Gomes 1,2, Juliane F. Oliveira 2, Adelmo Bertolde3, Diepreye Ayabina1, Tuan Anh Nguyen4, Ethel L. Maciel5, Raquel Duarte6, Binh Hoa Nguyen4, Priya B. Shete7 & Christian Lienhardt8,9 Global stakeholders including the World Health Organization rely on predictive models for developing strategies and setting targets for tuberculosis care and control programs. Failure 1234567890():,; to account for variation in individual risk leads to substantial biases that impair data inter- pretation and policy decisions.
    [Show full text]
  • Food and Health in Europe: Europe: in Health and Food WHO Regional Publications
    Food and health in Europe: Food and health WHO Regional Publications European Series, No. 96 a new basis for action Food and health in Europe: a new basis for action 96 The World Health Organization was established in 1948 as a specialized agency of the United Nations serving as the directing and coordinating authority for international health matters and public health. One of WHO’s constitutional functions is to provide objective and reliable information and advice in the field of human health, a responsibility that it fulfils in part through its publications programmes. Through its publications, the Organization seeks to support national health strategies and address the most pressing public health concerns. The WHO Regional Office for Europe is one of six regional offices throughout the world, each with its own programme geared to the particular health problems of the countries it serves. The European Region embraces some 870 million people living in an area stretching from Greenland in the north and the Mediterranean in the south to the Pacific shores of the Russian Federation. The European programme of WHO therefore concentrates both on the problems associated with industrial and post-industrial society and on those faced by the emerging democracies of central and eastern Europe and the former USSR. To ensure the widest possible availability of authoritative information and guidance on health matters, WHO secures broad international distribution of its publications and encourages their translation and adaptation. By helping to promote and protect health and prevent and control disease, WHO’s books contribute to achieving the Organization’s principal objective – the attainment by all people of the highest possible level of health.
    [Show full text]
  • Download Abstract Book
    DEEPER INSIGHT FROM BIG DATA AND SMALL AREAS PORTO | PORTUGAL | 07 - 09 SEPTEMBER 2017 Table 3 Organisation of Contents 4 Venue 5 Social Programme 7 Extra Social Programme 9 Informations 11 Pre-Conference Workshops 11 Modelling spatial and spatio-temporal areal unit data in R with CARBayes 12 Health Applications of Google Earth Engine 13 Scientific Programme 25 Invited Speakers | Short Biographies 85 Plenary Sessions 85 Plenary Session I 87 Plenary Session II 89 Plenary Session III 93 Oral Communications 93 Parallel Session 1 | GIS In Public Health I 103 Parallel Session 2 | Spatial Health Surveillance I 111 Parallel Session 3 | Spatial Health Surveillance II 121 Parallel Session 4 | Spatial Survival And Registry Data Analysis I 127 Parallel Session 5 | Spatial Survival And Registry Data Analysis II 135 Parallel Session 6 | Clustering Of Temporal Trends In Space-Time Disease Mapping 143 Parallel Session 7 | Data Science Applied To Health: Strategies And Tools For Big Data, Machine Learning And Data Mining 151 Parallel Session 8 | Modifiable Areal Unit Issues And Methods 159 Parallel Session 9 | Social Networks And Spatial Epidemiology: Tools, Opportunities And Challenges 167 Parallel Session 10 | Modelling Climate-Sensitive Disease I 173 Parallel Session 11 | Modelling Climate-Sensitive Disease II 183 Parallel Session 12 | Agent-Based Modelling Table of Contents 189 Parallel Session 13 | GIS In Public Health II 203 Parallel Session 14 | Modelling And Inference In Infectious Disease Epidemiology 211 Parallel Session 15 | The Use Of Linked
    [Show full text]
  • Health for All? in Recent Years, a Considerable Number of Countries Have Developed and Implemented Strategies Aiming at Reducing Inequalities in Health
    Health for all? In recent years, a considerable number of countries have developed and implemented strategies aiming at reducing inequalities in health. However, knowledge of effective policies or strategies to reduce socioeconomic inequalities in health is still very fragmented. The aim of this book is to describe and compare different European health equity strategies and their potential successes. The main part of the material comes from a comparative study of national public health strategies for equity in health with the following participating countries: Denmark, Finland, England, Italy, Netherlands, Norway, Spain and Sweden. National experts wrote the country chapters which not only cover questions concerning whether their countries were taking measures on the individual public health problems – such as smoking, alcohol or physical activity – but also if the policies had considered the wider, social determinants of health and experiences of the potential implementation processes. This publication presents an up-to-date picture concerning equity- oriented public health policies in Europe. However, there is considerable lack of relevant data to enable comprehensive comparisons and analyses of successes and problems with the implementation and monitoring of health equity policies. We hope the book will stimulate continued efforts to harmonise relevant data collections and improve collaborative analyses aiming at shaping an evidence base for policy decisions about the most effective ways to promote equity in health. Health for all?
    [Show full text]
  • The Accuracy of Self-Report Versus Objective Assessment for Estimating Socioeconomic Inequalities in Disease Prevalence in Indonesia
    International Journal of Public Health (2019) 64:1233–1241 https://doi.org/10.1007/s00038-019-01301-5 (0123456789().,-volV)(0123456789().,- volV) ORIGINAL ARTICLE The accuracy of self-report versus objective assessment for estimating socioeconomic inequalities in disease prevalence in Indonesia 1,2 2 2 Joko Mulyanto • Dionne S. Kringos • Anton E. Kunst Received: 29 March 2019 / Revised: 11 September 2019 / Accepted: 11 September 2019 / Published online: 17 September 2019 Ó The Author(s) 2019 Abstract Objectives To estimate socioeconomic inequalities in hypertension and asthma prevalence in Indonesia, to compare estimates based on self-report (SR) to those based on objective assessment (OA), and to assess the role of sensitivity and specificity of SR. Methods We used data from the 2014 Indonesia Family Life Survey (n = 34,257). We measured inequalities in hyper- tension and asthma prevalence in relation to educational level and income, using standardised prevalence rate and the relative index of inequality (RII). Using OA as standard, we calculated the sensitivity and specificity of SR. Results For hypertension, reversed inequalities were found when estimated by SR instead of OA (RII for education 0.86, 95% CI 0.74–0.99 vs. RII 1.29, 95% CI 1.16–1.44). For asthma, a similar but even larger reversal of inequalities was found. The sensitivity of SR was low overall, and especially for the lowest education or income group. Conclusions Results imply that the use of SR may lead to underestimation of socioeconomic inequalities in disease prevalence in a low-income country such as Indonesia. The use of OA is recommended for monitoring inequalities in non- communicable disease prevalence.
    [Show full text]
  • Book of Abstracts
    Conformity, Dialogue and Deviance in Health and Medicine Society for the Social History of Medicine Conference 11-13 July 2018 University of Liverpool ABSTRACTS #SSHM2018 1 ROOMS: A: CTH-LTB/ B: CTH-LTC/ C: CHAD-BARKLA/ D: CHAD-ROTBLAT/ E: CTH-LTD/ F: CHAD-CHADWICK Keynote abstracts Wednesday 11 July 2018 17.15-18.45: Ruth Richardson, The Significance of n of 1: A Mid-Victorian Case Report, CTH-LTA Until quite recently, interest in “n of 1” reports had dwindled in medical literature, eclipsed by the preponderance of data from randomised controlled trials. But in history the exemplary quality of the single case in allowing light to penetrate dark corners of our ignorance remains understood, valued and appreciated. This lecture focuses upon a non-random, non-blinded and unrepeatable n of 1 crossover trial in the past. A sequentially-informed account of the hospital care of the same patient in two different institutions, it provides clear evidence of the contemporary operation of differing medico-surgical regimes and their concomitant modes of nursing care, in close geographical proximity. This case offers an extraordinary supplementary record which illuminates and enriches institutional, scientific, and social histories of mid-19th century healthcare. Thursday 12 July 2018 17.45-19.00 Martin Gorsky, Universal Health Coverage as a Goal of International Policy: Dialogue, Consensus and Conflict, CTH-LTA Amongst other major anniversaries (the NHS, the WHO) 2018 also marks 40 years since the WHO’s Alma Ata Declaration. This was a pledge by the international community to achieve Health for All by the Year 2000 through universal primary health care.
    [Show full text]
  • Wealth Matters for Health Equity Authors
    REPORT September 2018 Wealth Matters for Health Equity Authors Paula Braveman, University of California, San Francisco Julia Acker, University of California, San Francisco Elaine Arkin, Independent Consultant Dwayne Proctor, Robert Wood Johnson Foundation Amy Gillman, Robert Wood Johnson Foundation Kerry Anne McGeary, Robert Wood Johnson Foundation Giridhar Mallya, Robert Wood Johnson Foundation Acknowledgments We thank the following individuals who provided insightful and substantive comments on drafts: Susan Egerter, University of California, San Francisco David Erickson, Federal Reserve Bank of San Francisco Kate Griffin, Prosperity Now Doug Jutte, Build Healthy Places Network Daniel Lau, Build Healthy Places Network Tracy Orleans, Robert Wood Johnson Foundation Suggested Citation Content from this publication may be reproduced without permission provided the following citation is referenced: Braveman P, Acker J, Arkin E, Proctor D, Gillman A, McGeary KA, Mallya G. Wealth Matters for Health Equity. Princeton, NJ: Robert Wood Johnson Foundation, 2018. Foreword This report also offers an Executive Summary. Other reports on health equity from the Robert Wood Johnson Foundation (RWJF) include Early Childhood Is Critical for Health Equity and What Is Health Equity? And Contents What Difference Does a Definition Make? This report defines health equity (below) and takes a deeper look at what it means, as well as implications SECTION 1 2 for action. These reports aim to assist those working in public health, health Introduction care, and other fields that powerfully shape health—such as education, child care, employment, housing, and community development—to build a SECTION 2 3 world in which everyone can be as healthy as possible. Wealth and Health Are Closely Linked Health equity means that everyone has a fair and just opportunity to be as healthy as possible.
    [Show full text]
  • Introducing Risk Inequality Metrics in Tuberculosis Policy Development
    1 Introducing risk inequality metrics in tuberculosis policy 2 development 3 M. Gabriela M. Gomes1,2*, Juliane F. Oliveira2, Adelmo Bertolde3, Diepreye 4 Ayabina1, Tuan Anh Nguyen4, Ethel L. Maciel5, Raquel Duarte6, Binh Hoa Nguyen4, 5 Priya B. Shete7, Christian Lienhardt8,9 6 1Liverpool School of Tropical Medicine, Liverpool L3 5QA, United Kingdom. 7 2CIBIO-InBIO, Centro de Investigação em Biodiversidade e Recursos Genéticos, 8 Universidade do Porto, 4485-661 Vairão, Portugal. 9 3Departamento de Estatística, Universidade Federal do Espírito Santo, Vitória, 10 Espírito Santo 29075-910, Brazil. 11 4National Lung Hospital, Hanoi 10000, Vietnam. 12 5Laboratório de Epidemiologia, Universidade Federal do Espírito Santo, Vitória, 13 Espírito Santo 29047-105, Brazil. 14 6Faculdade de Medicina, and EPIUnit, Instituto de Saúde Pública, Universidade do 15 Porto, 4050-091 Porto, Portugal. 16 7Division of Pulmonary and Critical Care Medicine, University of California San 17 Francisco, 94110 San Francisco, USA. 18 8Global TB Programme, World Health Organization, 1211 Geneva 27, Switzerland. 19 9Unité Mixte Internationale TransVIHMI (UMI 233 IRD – U1175 INSERM – 20 Université de Montpellier), Institut de Recherche pour le Développement (IRD), 21 34394 Montpellier, France. 22 23 * Correspondence and requests for materials should be addresses to M.G.M.G. (email: 24 [email protected]). 25 1 26 ABSTRACT 27 Global stakeholders including the World Health Organization rely on predictive 28 models for developing strategies and setting targets for tuberculosis care and control 29 programs. Failure to account for variation in individual risk leads to substantial biases 30 that impair data interpretation and policy decisions. Anticipated impediments to 31 estimating heterogeneity for each parameter are discouraging despite considerable 32 technical progress in recent years.
    [Show full text]
  • HEAT): Practice Example Antimicrobial Resistance (AMR
    Health Equity Assessment Tool (HEAT): practice example Antimicrobial resistance (AMR) PHE Health Equity Assessment Tool (HEAT) Antimicrobial resistance (AMR) – practice example Programme or project being Antimicrobial resistance campaigns and interventions assessed Date completed August 2017 Contact person (name, Dr Diane Ashiru-Oredope, HCAI & AMR Division: [email protected] ; directorate, email, phone) Viviana Finistrella, HCAI & AMR Division, National Infection Service: [email protected] Lina Toleikyte, National Health Inequalities Team: [email protected] Name of strategic leader Dr Diane Ashiru-Oredope Your response – remember to consider multiple dimensions of inequalities, including protected characteristics and Steps to take socio-economic differences A. Prepare – agree the scope of work and assemble the information you need 1 2 1. Your programme of work AMR is a global threat to public health affecting all healthcare systems and growing at an alarming pace. , What are the main aims of your The implementation of antimicrobial stewardship programmes has been used within secondary care to help work? reduce this burden, with a focus on the UK Government ambition to reduce inappropriate antibiotic 3 prescribing. An important element of these programmes is the use of national campaigns to increase the How do you expect your work to overall reach. reduce health inequalities? This HEAT assessment considers 4 of these national campaigns: • the Antibiotic Guardian campaign – a pledge-based system where
    [Show full text]
  • King, Brian (2017)
    HEALTH TOMORROW, VOL. 5 (2017) King, Brian (2017). States of Disease: Political Environments and Human Health. Oakland, California: University of California Press. ISBN 9780520278219 Reviewed by Sue G. Lurie, PhD This book by a health geographer applies the concept of social ecology, along with interdisciplinary theories of social conditions and determinants of health and health inequity, to analyze the impacts of changing political environments on human vulnerabilities to disease and illness. Key issues in health and wellness and disease prevention and management in South Africa are addressed, which have broader implications for the developing world. Comparative analysis of health policies is centered on political history from apartheid to democratic elections, with effects on changing explanations of disease causation, policies on preventive strategies, and access to antiretroviral treatment for HIV/AIDS. The environmental impacts of economic development and climate change on food insecurity and disease management, roles of non- governmental organizations, foreign aid and international economic development are related to variations in local capacities for improving and maintaining population health and health care. The author’s thesis is that spatial processes of negotiation for resources in political environments are integral in both disease epidemiology and community responses, with long- term implications for health of local populations. Based primarily on his extensive field research on HIV/AIDS and malaria in South Africa over a fifteen year period, this perspective is applied to expand the field of medical geography. The book complements research by physician/ anthropologist Paul Farmer (2015) on HIV/AIDS in rural Haiti, Rwanda and Lesotho since the 1980s, and policy advocacy for reducing poverty and inequity in international health, as cited by the author.
    [Show full text]
  • Claudia Chaufan University of California San Francisco Rose
    THE ELEPHANT IN THE ROOM : THE INVISIBILITY OF POVERTY IN RESEARCH ON TYPE 2 D IABETES Claudia Chaufan University of California San Francisco Rose Weitz Arizona State University ABSTRACT Over two hundred years of anecdotal, epidemiological, and experimental evidence indicate that poverty breeds disease. This holds true for type 2 diabetes, which both in the United States and other developed nations disproportionately occurs, cripples, and kills among the poor. In this article we examine rhetorical strategies used in 30 journal articles indexed under type 2 diabetes and poverty. As we show, poverty is rarely highlighted in this literature as a causal factor. Instead, explanations for diabetes among poor people overwhelmingly emphasize features of patients—their biology, behaviors, psychology, culture, or other “risk factors”—while ignoring, reframing or neglecting the links between poverty and disease. By so doing, these discursive strategies naturalize higher rates of diabetes among poor persons, legitimize relations of domination in the larger society, and encourage only research projects, treatment practices and health and social policies that do not challenge existing social relations. We discuss the implications of these discursive practices for medical research and care, and for social and public health policies. PERSONAL REFLEXIVE STATEMENTS Claudia Chaufan In the late nineties, as a newcomer to America trained as a clinical diabetologist in Argentina, a job as a diabetes educator for Latinos opened my eyes to a political reading of diabetes and of diabetes inequalities. As I learned about Latinos’ life and health chances and contrasted them against public discourses around their “high risk” status—built around ill-defined “genetic predispositions” and decontextualized “lifestyle choices”—I opted for an HUMANITY & S OCIETY , 2009, VOL .
    [Show full text]